Healthcare Provider Details

I. General information

NPI: 1063074219
Provider Name (Legal Business Name): SWEET THERAPY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 NILES VIENNA RD
VIENNA OH
44473-9519
US

IV. Provider business mailing address

547 NILES VIENNA RD
VIENNA OH
44473-9519
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-9539
  • Fax: 716-219-5048
Mailing address:
  • Phone: 330-519-9539
  • Fax: 716-219-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: VANESSA VINCE-DENIRO
Title or Position: COUNSELOR
Credential: MSED, LPCC, LSW
Phone: 330-519-9539